Behavioral Optimization for Overcoming Suboptimal Treatment Retention (BUP-BOOSTeR)

The investigators will leverage the Multiphase Optimization STrategy (MOST) framework for developing, optimizing, and evaluating a multicomponent behavioral intervention. The impact of three psychosocial intervention components on buprenorphine treatment retention at six months will be tested by recruiting persons initiating buprenorphine from office-based addiction treatment settings and randomizing them in a balanced 2x2x2 factorial design to some combination of the following 3 intervention components:

• Behavioral-Activation (BA)-focused on increasing positive reinforcing activities and experiences to promote recovery;
• Attendance Reinforcement (AR)- incentivizing attendance at addiction clinical care visits; and
• Peer Motivational Interviewing (Peer-MI) -increasing confidence to continue buprenorphine treatment and providing social support.

All participants will receive usual care, including brief advice to continue treatment for at least 6 months.

The observed main and interaction effects for the 3 candidate psychosocial interventions will guide the selection of components to be included in an optimized intervention (the end goal of this project).

Results from this study will be twofold:

• improve the understanding of mechanisms by which psychosocial component interventions improve buprenorphine MOUD treatment retention, and
• prepare the scientific team to conduct a future randomized controlled trial of the optimized intervention package.

The long-term impact will be to establish a psychosocial intervention package that improves retention in buprenorphine treatment.

Inclusion criteria

• 18 years of age or older
• Meet DSM V criteria for opioid use disorder during the past year
• Be a patient in Office Based Addiction Treatment who has initiated buprenorphine in the last 30 days AND has had no use of prescribed buprenorphine in the 7 days before the current treatment episode AND has not received long-acting injectable buprenorphine in the 6 weeks before the current treatment episodes OR Be a person within the first 30 days of release from a carceral setting who is taking any formulation of buprenorphine for their OUD and who is within their first 30 days of intake at OBAT.
• Be willing to provide informed consent, be randomized, and complete study materials
• Be able to speak and read English sufficiently to complete study intervention and procedures
• Be willing to provide the study access to their electronic medical records
• Have no plans to change Office Based Addiction Treatment clinics during the study

Exclusion criteria

-Be receiving hospice or other end of life medical care